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This blog is an article in the last issue of the excellent New Pathways MS magazine, which they have kindly allowed me to share on my blog, too!

Hello and thanks for inviting me to do a regular column with New Pathways. As an MS Nurse with an interest in integrative medicine/ holistic health, when I explore a topic here, I will generally move from the conventional advice to exploring some of the more natural approaches that may also help.

Recent interactions with one of my very young patients, got me focussing on anxiety and PANIC ATTACKS! So here goes

Panic attacks are intensely frightening events that happen when our systems are overloaded with stress hormones, causing a dry mouth, pounding heart, feeling of shortness of breath, dizziness, shaking, and sometimes, tingling ( as we hyperventilate) and chest pain. It can feel as if you’re about to die – which of course, increases the anxiety! After a nasty experience with a panic attack, it can be easy to develop a fear of having another one.

Starting with the conventional, tell your GP what’s happening. The NICE guidelines for the medical management of panic attacks recommend firstly, education and monitoring, secondly, Cognitive behavioural therapy (CBT) or relaxation therapy, and only in extreme cases that do not resolve, an anti-depressant medication, such as sertraline ( which can have the dangerous side effect of causing suicidal thoughts in a minority of people)

I had my own experiences with panic attacks as a teenager, living abroad and drinking way too much coffee for my system, so all these suggestions come from an amalgamation of personal experience, nursing experience and learning!.

So let’s have a look at both immediate and long term strategies for mastering this problem.

If you feel one coming on:

Remember: Panic attacks aren’t dangerous. Remind yourself that it’s happening because of anxiety; your body is OK, and the very worst that could happen it that you could become dizzy from breathing too fast , and pass out, after which, your body will regulate itself again, and you’ll go back to normal. If you’re driving, pull over.

Change your focus from scary sensations, to something else that’s tangible – a sound, a feeling, a smell – part of being ‘mindful’ I found that focussing on something else – squeezing my toes and calf muscles, for instance, could distract me. Even searching for a specific item in a supermarket, or counting. Having someone chatting to you, perhaps, squeezing or massaging hands, also helps.

Regulate your breathing. Slow your breathing and count it in and out, starting with a count of three, and slowing if you can, to a count of five.

Rescue Remedy is a homeopathically diluted ( meaning that it works on an energy level, rather XX UNLIKE than like herbal or conventional medicine, and is safe to take whatever other tablets you may be on) Bach flower remedy, that many people find effective for times of crisis. See http://www.nelsonsnaturalworld.com/en-gb/uk/our-brands/rescue-remedy/the-rescue-story.There is also a spray, and pastilles; use when you feel at risk of panic attack.

Preventing further panic attacks.

Gaining mastery over our states of mind is a lifelong learning process, and something we will probably never completely perfect. However, there are ways to prevent complete overwhelm from ruling us.

Anxiety and panic attacks can be very isolating. Connecting with others and having their support defuses this feeling, so tell other people who care about you, and let them know how they can help you through.

In healthcare, we have a tendency to medicalise everything, and by doing this, we sometimes miss the obvious. It’s worth taking some time to think about the practical issues that may be causing feelings of anxiety and panic, and to ask – are there are any practical actions that can be take to make things easier? If something feels overwhelming, is there any help you can get? Can deadlines be extended? Can you get workplace support? Do you have to do things in the same way or can changes be made? Can a charity be approached to help fund an item that would help, but that you can’t afford? I often use www.Turntous.org for this. Getting organised, setting realistic goals, getting help, and taking small steps and deciding on future steps can help to restore a sense of equilibrium.

Because the hormones caused by stress are ‘burned up’ by exercise, making exercise, as much as you can, a regular part of your routine, is a powerful assistance in prevention.

Unstable blood sugar can also contribute to panic attacks, so coming off sugar and eating whole foods is helps. Coffee can cause anxiety and panic symptoms all by itself in susceptible individuals, so cut caffeinated coffee out completely.

One of the most powerful tools to become more resilient to stress and prevent anxiety and panic attacks that I have found ( through personal experience) is something called HeartMath. This is a very simple technique where you breathe in a rhythm of 5 (seconds) in, 5 out, in one continuous flow, whilst focussing on heart felt positive emotions, in the heart area. Technology can be added to allow teaching or self-monitoring using gadgets, or a sensor connected to heart rate variability display, but the basic technique is as free and as old as the hills; however, done regularly, it has the most profound effect on resilience to stress and mental, emotional and physical health. See https://mirandasmsblog.com/category/heartmath/ for my study in people with MS, and http://www.heartmath.com for more information.

Likewise, anything that helps to restore a connection to a sense of inner peace –

meditation, deep relaxation, helps to prevent overwhelm and retain balance. You don’t need technology to meditate, but there are loads of apps available now for phones, like http://www.headspace.com. These type of things need to be done daily to build resilience to stress, to be effective.

Moving into the world of energy and its flow, certain positions help to ‘ground’ us and defuse overwhelming feelings of panic. There’s a wealth of yoga exercises that strengthen and ground, but also some quick tricks, like ‘Cook’s Hook-ups’ from Educational Kinesiology: watch this video, and do try this at home!https://www.youtube.com/watch?v=W8Ns-2yENgc

It’s not always possible to take up a strange position, especially if you’re at work or on the tube for instance! But Mudras, or hand-yoga is often possible!. Mudras change the flow of energy around the body, affecting physical and mental states, and are a part of the Indian system of medicine called Ayurveda. Here’s a link to the mudras for anxiety and depression https://youtu.be/X8OgsX9b3JA.

image from http://www.stylecraze.com/articles/8-yoga-mudras-to-overcome-any-ailments/#gref

In summary, panic attacks can be caused by many factors, so having a multi-factorial approach, with patience, to achieve the goal of mastering them, makes sense. I hope these resources are useful, and if you have your own personal tips, please do share them by commenting.

We very sadly recently lost a member, who died as a result of a deep vein thrombosis, or DVT. A DVT is a clot that forms in the leg, but then travels in the circulation and blocks off a narrower blood vessel somewhere else in the body. Our greatly missed friend was someone who could walk, with a frame, but only just. A powerful frame, tall, with a bit of weight – these things put more pressure and constriction on the veins in a seated position. On his own admission, he didn’t drink much throughout the day. He hadn’t been able to access his physio or exercise in the gym for some weeks as awaiting a wheelchair accessible vehicle, and mobilising was a struggle – he was awaiting a baclofen pump.

We wanted to get everyone thinking about their own risk factors, and please, to take the necessary steps to help avoid this sudden and possibly fatal incident.

The main cause of DVT is immobility – especially during or after surgery, but can occur without surgery. Things you can do to protect against DVT include:

regular brisk walking – not always possible I know! But even whilst sitting,

If possible, regularly circle your ankles, get into a ‘tiptoe’ position and then lift your toes off the floor whilst keeping your heels on the ground.

when resting, when possible, spend some time with your feet higher than hip height.

Stay well hydrated – this keeps the blood less sticky and less likely to clot.

If you are not able to move your legs, consider wearing ‘travel socks’ or ‘flight socks’. These are equivalent to grade 1 thrombo-embolytic deterrent (TED), or ‘compression’ stockings.

If your legs are swollen, or you have had thrombophelbitis, you can talk to your GP about getting grade 2 or 3 ( tighter) TEDs on prescription. You may need to first have test with a hand held Doppler scanner, done by a nurse.

They are available in different colours, and in open or closed toe options.

They should be removed at bedtime and put on first thing in the morning. It is important to put them on before your legs start to swell in the mornings.

Stockings should be replaced every 3-6 months. Each time you should be measured again, just in case the size needs to be changed.

You should always have at least two pairs prescribed so that one pair can be washed and dried while the other is worn.

Do not tumble dry support stockings, as this may damage the elastic.

They can be made to measure if none of the standard sizes fit you.

Support stocking applicator aids are available if you are unable to get them on. You can discuss this with your pharmacist or nurse.

A DVT that is recognised in time can be treated to prevent further complications. So what to watch out for?

Pain and tenderness of the calf.

Swelling of the calf.

Colour and temperature changes of the calf. Blood that would normally go through the blocked vein is diverted to outer veins. The calf may then become warm and red.

If you have any of these symptoms, with no other explanation, seek medical help immediately, to be safe.

One talk caught my eye in the COPA brochure this year. Compared to the glamour and hard sell of some of the technologies on exhibit, this sounded like an old-fashioned modest but serious research project. It was presented by a nurse from a Multiple Sclerosis Therapy Centre in Bedford. “Interventions for neuropathic pain.” Now neuropathic pain is not something I see all the time, but people do present with it, sometimes as a secondary problem. They have often lived with it and don’t generally expect me to be able to help much. While I have sometimes had good results it has always been something of a mystery to me. So this was potentially a very useful talk.

The Problem of Neuropathic Pain

I got a seat early: luckily, as it was standing room only by the time Miranda Olding began. She described neuropathic pain as an “unpleasant lesion or disease…

Like this:

This drug trial is now recruiting for people with PPMS, in London. It’s a drug with exciting possibilities, not a ‘repurposed’ medication.

Here’s what Professor Giovannonni of Barts hospital and http://multiple-sclerosis-research.blogspot.com has to say about Laquinimod:

“As you are aware I am very impressed by the laquinimod phase 3 results. Why? Laquinimod is a drug that does not have much effect on inflammatory MS disease activity, i.e. relapses and MRI activity (Gd-enhancing and new T2 lesions). Despite its weak anti-inflammatory effects laquinimod has an impact on disability progression, that appears to be independent of relapses and it slows the rate of brain atrophy. All this points to laquinimod having neuroprotective effects downstream of inflammation. It now appears that laquinimod may be working on glial cell activity and the innate immune system; laquinimod down-regulates the mechanisms responsible for the slow-burn we see in MSers. Are the laquinimod results reliable? Almost certainly they are; why? Mainly because there has been two large phase 3 studies showing the same effect. This makes the chances of this being a chance result highly unlikely.”

Exciting opportunity if it feels like you have nothing to lose, but ALWAYS REMEMBER TO ASK THESE QUESTIONS!

Questions to ask when considering taking part in a trial:

What are the potential risks?
How many people/ what percentage have these risks
What are the potential side-effects?
How many people /what percentage get these?
What can be done if I do have a side effect or risk? Is it reversible?
What are the potential benefits?
What percentage have had these benefits?
How much of these had similar condition at a similar stage to me?
How long do they last?
Is more treatment necessary?
How much does it cost?
Will you give information either to me or to my doctor about what therapy I have undergone?
How will I be monitored? Eg scans, bloodtests etc
How often will I have to return for follow up? Is there a charge?
Will they pay my travel expenses?
How will I know if it’s worked? What’s the timescale for improvement?
Is there a placebo ( dummy drug) group? If I’m in the placebo group, and the real treatment group benefit, will I have the chance to change to the treatment group?
If I have the treatment during the trial, and benefit from it, will I be able to carry on with it long term?

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This is just a fun one! THANKYOU to all who have donated, here’s us ( Miranda, Simon, Rose, Joe and Beanna Olding) doing the Mad Monk XRunner for the Beds & Northants MS Therapy Centre, & the MS Trust.

So… it started with some nerves from my little Beanna….

There was a warm up & a good atmosphere at the start, couple of fireworks to send you off,

then straight into the stream – ( where I fell over because I was messing with my phone) – up the bank,

What’s that?’ Spiders web’, straight ahead? through the web, under the nets

Beautiful Rose

run run run

Then into the RIVER?!

some casualties….then up and over….

I said Over, dammit! … Dad to the rescue

then it was down that waterslide ( film) – over the river, & out the other side

Over the nets, over the bars, through the tubes

more running – simon faking it –

Then a few obstacles, and on to the finish line – Yay Team Olding! …. it’s on this little film

by the way, the phone cover I used was an ‘Ipega’; I got it for 14.99 and it seemed pretty cheap from china… but my phone survived!

If you’d like to help boost the fantastic total that people have helped us to raise, our just giving pages are open until the 17/8/14 – please use the just giving buttons at the side of the page at the top – Thankyou!!

Like this:

As Benjamin Franklin once said, there are only 2 certainties in life; death, and the taxman, (!) and you don’t need to have a life-limiting condition to make plans about what you want to happen in various circumstances that could, possibly, end life. But how many of us have?

At the MS Therapy Centre in Bedford, we sadly lost a member recently; who’d been getting along, managing with lots of disability, but had a very mellow outlook, a sunny smile, and life was still sweet. However, a sudden infection in this sort of case, can prove fatal, and this time, sadly did. Losing her company coincided with me visiting Leeds for an excellent study day run by the MS Trust, about end of life issues.

Hello Leeds! & Thankyou, MS Trust

Well, I can tell you that as a nurse, I’m perhaps more aware of the ‘circle of life’, and my husband is under strict instruction that should anything ever happen to me, he must ensure that my legs are shaved and my makeup is on at all times – and apart from that, I’m not bothered!

dear hubby, – don’t let this happen!

But what other options are there, and how can you ensure that what you want to happen, will happen?

What I learned yesterday, is that although there are various forms you can fill out, it is just as valid to put your wishes in a letter, to be shared with the GP and close family/friends, kept with your notes with any health or care providers, and on the fridge at home if you have been going in and out of hospital recently.

Planning for future care doesn’t mean that you can’t change your mind later, and restate your intentions, but sometimes, if you do become very unwell or disabled, it can be hard to make your wishes clearly known. Putting your wishes down on paper can give you more control, and give yourself and family members of carers peace of mind, that in the heat of the moment, what happens is what you want to happen.

In law, we don’t have the right to demand certain medical treatments, and the default position of our health service is to always treat what can be treated. We do have the right to refuse various types of treatment however. So things to think about are:

If you were taken ill with an infection, would you want to be taken to hospital, or treated at home?

If you weren’t able to take antibiotics as tablets, would you want them intravenously? This can also be organised at home in most areas.

If you were extremely poorly, would you want to be put on a ventilator?

If your heart stopped, would you want to be resuscitated?

If the answers to these questions depend on different circumstances, what would those circumstances be?

In the event of becoming very ill or unable to communicate, what is important to you?

See me to discuss these issues further, or help to draft up a letter.

On a lighter note (SUUUUUUCH a bad pun!) Last year, one of our members emailed me to let me know how much better he was feeling after just a short time using a lightbox. Here’s what he said then:

Hello Miranda,
Further to our chat in the car park at the MS Therapy Centre on Thursday, here is the link to the light box I was talking about:http://www.amazon.co.uk/SAD-Light-Box-Medically-Certified/dp/B00A6SHSHY I found it on Amazon for £44, plus about £5 p+p, which gives a total cost of about £50. There are others which cost in excess of £100 but, having read the reviews and specifications, they all seem to do the same job.

In my totally unscientific testing, I’ve found that I feel better and have fewer symptoms if I have the light on when daylight levels are low. So I use it when it is raining, fully cloudy, or just more cloud than sunshine and mainly first thing in the morning and towards the evening. I have it sitting about 3 to 4 feet away, at head height and just over my right shoulder when I’m working at my desk on my computer. I wouldn’t recommend having it pointing at one’s face as it is very bright and would likely lead to eye strain.

I have only had it about a month, but have noticed a difference on days with heavy clouds when I haven’t used and when I have. I’m looking forward to seeing what difference it will make this coming winter. If you’re interested, I’ll let you know in the Spring whether it worked or not.’

Well, in the interests of science, journalism and health, I thought I’d follow that up after 1 year, in these gloomy days of February! And the answer is, Yes! He still finds this very helpful, reporting that the warmth and brightness give a definite sense of wellbeing, it appears that urinary urgency is reduced, and he has a marked decrease in fatigue/improvement in energy levels, and is able to work until about 5.30, instead of about 3.30pm each day. Very Interesting. Thankyou, mystery tester.

Remember that lightboxes don’t get you making vitamin D, which is important especially at this time of year; a sunbed will, as long as it includes UVB rays. As long as you’re responsible about your skin ( not using sunbeds to get a tan, but a quick dose to just before you start to change colour) there’s no harm in using both… but roll on summer!